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HOUSE OF REPRESENTATIVES
STATE HOUSE STATION AUGUSTA, MAINE 04333-0002
2
(207) 287-1400
1
Andrew M.
Westbrook,
Residence:
Business:
TTY:
Gattine
Street
(207) 287-4469
529 Stroudwater
ME
Mail:
dgattine@a0l.com
Temporary Assistance
to
Human Services
members of the
Gattine, and
l
Joint Standing
Committee on Criminal Justice and Public Safety, I 126 which is part of the City of Westbrook. I am here today to present LD 1829 - An Act to Require the Department of Health and Human Services to Report Annually on Investigations and Prosecutions of False Claims Made under the MaineCare, Temporary Assistance to Needy
Families and
am Drew
represent District
human
services programs
We have an obligation as
make
dispensed for the purpose for which they are allocated and deliver the optimal value for the people and programs they serve. The State, through the Department of Human Services,
manages multiple programs designed to deliver public support to Maine citizens and the integrity of each of those programs must be maintained through efforts that are comprehensive, fair and based on facts. The public has a right to know that program integrity measures are in effect that
ensure that funds that support public programs are spent effectively and appropriately. Preventing and detecting fraudulent, abusive, and wasteful practices is an essential responsibility of Maine government. Fraud, waste and abuse have a negative impact on everyone involved in the system, including the recipients of services; the taxpayers who pay for them; and providers
A failure to maintain
program integrity undermines program functioning and diverts scarce and valuable resources from their mission. It can seriously diminish public trust in the ability to deliver taxpayer-funded assistance in an accountable and transparent manner.
District l26
Westbrook
(part)
Printed on recycled paper
Program integrity includes the ght against fraud but is much more than that. A comprehensive and modern program integrity curriculum includes all of the traditional fraud, waste and abuse that: tools focusing on investigation, recovery and prosecution and recovery but also assures
-
make
sure that
all
and expectations The Department has appropriate, well designed and well functioning systems in place to make sure that ftmds and benets are dispensed in accordance with the rules The Departments resources deployed to manage, investigate and audit these programs have the best information and tools available to them and are focused on the activities that will have the greatest scal and law enforcement impact The Department is coordinating to the maximum extent possible with other agencies, Generals office including but not limited to the federal government and the Maine Attorney
The Department
maximizing the use of technology, including technology that has already been purchased and implemented, in its program integrity efforts The Departments processes for recovering money and avoiding improper expenditures are effective, efcient and fair to all stakeholders
is
do the best job in program integrity take a measured and comprehensive approach understand that begins with a data driven assessment. You cannot solve a problem unless you what the problem is, what causes it and how to measure it. In government especially, resources will always have limits and you will always have competing priorities for administrative lnctions and unless you understand the extent of the problems and what the problem is costing
The
states that
'
This legislation will require an annual report from DHHS to the Joint Standing Committees on Appropriations and Financial Affairs and Health and Human Services that will describe in detail that will allow the all of the Departments program integrity efforts along with information We already make a efforts. those of legislature to evaluate and determine the effectiveness
signicant investment in these activities and we need to be in a position where we can assess the effectiveness of that investment before we invest more. The report will focus on the MaineCare,
TANF
resources are organized and deployed within the Department, information about the number of cases opened, the dollars identied and the dollars recovered
b.
Appropriate information regarding fraud cases referred to the Attorney Generals Health Care Crimes Unit, understanding that detailed information regarding on-
c.
going criminal investigations cannot be disclosed An evaluation of the performance of the Departments vendors with respect to the duties they perform. Are we getting good value from them and are they focused
on the
right things?
d.
Information about the Departments participation in the various national how initiatives required by the federal govermnent, such as RAC and PERM and initiatives those initiatives either support or divert resources from other important
e.
The
f.
of any federal audits of the Departments program integrity activities, including weaknesses identied or best practices identied A description of any known defects, deciencies weaknesses in any systems managed or utilized by the Department that result in the improper or inaccurate payment of claims or benets including but not limited to the Depa1tments
results
Medicaid information system, provider enrollment system or eligibility determination systems. An estimate of the nancial impact of these issues and a
timeline for
g.
h.
These efforts are critically important. We have talked about them from time to time in this committee as issues and problems have come up. My sense is that in many of these areas the Department is doing very good job but in other areas we dont really have all of the information and provide the necessary to know whether or not that is the case. In order for us to do our jobs report proper level of support to the Department We need to see the complete picture and this
would be an important